An Education and Communication Outpost from an Athletic Trainer's Perspective

Prevention of concussion is a bit of an oxymoron; nothing we know about concussions can stop them from occurring while in action. HOWEVER, there is one way to prevent concussions – limiting exposure to the collisions that create a concussion. Moreover, research suggests – as well as observations – that being exposed to subconcussive hits can have detrimental effects on brain function. The subconcussive hits may even predispose someone to getting a concussion later on; this is obvious if you look at the data we have collected on NFL concussion over the past four years, (305 concussions in weeks 1-9 vs. 377 concussions in weeks 10-17) greater than a 20% increase as the season wears on.

Sports Legacy Institute has announced a certification program to further the Hit Count® initiative during a press release during Super Bowl week in New York City, today (along with the SLI Hit Count White Paper – see link below press release);

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Sports Legacy Institute Launches Hit Count® Certification Program in Collaboration with Leading Concussion Experts and Head Sensor Device Companies to Make Contact Sports Safer

Using Hit Count® Certified Products to Monitor and Minimize Brain Trauma Could Eliminate 500 Million Head Impacts in Football a Year, with the Goal of Reducing Risk of Concussion and Long-Term Brain Damage

New York City – January 27, 2014 – The non-profit Sports Legacy Institute (SLI) announced a major advance in the effort to prevent concussions and brain damage in contact sports today with the launch of the Hit Count® certification program after two years of development, which was unveiled at a press conference at the 2014 Super Bowl Media Center in New York City.

Hit Count® builds on the progress that head sensor device companies have made in developing devices that can measure acceleration of the head. Current products used on the field are focused on alerting coaches, medical professionals, and parents when a potential concussive impact occurs.

Inspired by Pitch Counts baseball, which set limits to the number of times a player throws from the mound to prevent arm injury, Hit Count® Certified Devices will have a second function that measures and “Counts” impacts that exceed the Hit Count® Threshold, set by a committee of leading scientists, with the goal of minimizing brain injury.

“Research using sensor devices has revealed that each year in the United States, there are over 1.5 billion impacts to the heads of youth and high school football players,” said Chris Nowinski, Founding Executive Director of SLI who launched the Hit Count® initiative in 2012 with SLI Medical Director Dr. Robert Cantu. “Most hits are unnecessary and occur in practice. By utilizing Hit Count® certified products as a teaching tool for coaches and a behavior modification tool for athletes, we can eliminate over 500 million head impacts next season.”

Committee member Gerry Gioia, PhD, of Children’s National Medical Center and George Washington University School of Medicine, unveiled that the Hit Count® Threshold will be set at the subconcussive level of 20 g’s of linear acceleration. “This is the beginning of a major research and public health effort to limit brain trauma in sports. While current science does not provide a “safe” or “unsafe” Hit Count®, our goal is to eventually provide clear guidance for coaches and parents. We will need the youth sports, sensor manufacturer, and medical science communities to work together to provide reliable answers.”

Hit Count® Certified products will go through a rigorous test protocol developed by the University of Ottawa Neurotrauma Impact Laboratory in conjunction with engineers from the six Hit Count® Initiative sponsors, including Battle Sports Science, G-Force Tracker, i1Biometrics, Impakt Protective, MC10, and Triax.

“Head sensor devices involve complex technology, and many sensors on the market today are not accurate,” said Dr. Blaine Hoshizaki, Director of the Neurotrauma Lab that developed the test, which is open to any company in the space. “Hit Count® Certification, the first and only sensor certification in the marketplace, will give consumer and research scientists the confidence that the sensors are accurately measuring impacts, providing simple and actionable data.”

G-Force Tracker, which is implanted inside football, ice hockey, and lacrosse helmets, is the first company to be Hit Count® Certified, with more products expected to be tested and certified later this year.

Pro Football Hall of Famer Mike Haynes, who joined the press conference and currently coaches his son’s 4th grade youth football team, said, “I wish this technology was available when I played.” Haynes noted a recent Virginia Tech-Wake Forest University study that found three youth football teams of 9-12 year olds had Hit Counts for the season that ranged from 61 to 145. “As a youth
football coach I have tried to limit brain trauma as much as possible, but I have never been able to quantify it and see how successful we are. Am I more like the team with 61 Hits or 145? Hit Count® Certified devices will allow me to adjust how I coach to make my son’s team safer.”

Three-time Super Bowl Champion Ted Johnson, a former linebacker for the New England Patriots who retired from post-concussion syndrome in 2005, said, “I track the number of steps I take each day to lower my risk of heart disease. I owe it to my son to count the number of Hits to his head in sports to lower his risk of concussions and subconcussive brain damage.”

The blue ribbon consensus committee that set the threshold included Drs. Robert Cantu and Ann McKee of Boston University, Kevin Guskiewicz of the University of North Carolina, David Hovda of UCLA, Gerry Gioia of Children’s National Medical Center, Blain Hoshizaki of the University of Ottawa, William Meehan of Harvard Medical School, and Kelly Sarmiento of the U.S. Centers for Disease Control and Prevention (CDC).

About the Sports Legacy Institute The Sports Legacy Institute (SLI) is a 501(c)(3) non-profit organization that was founded in 2007 by Dr. Robert Cantu and Christopher Nowinski to “solve the concussion crisis” by advancing the study, treatment, and prevention of the effects of brain trauma in athletes and other at-risk groups. SLI achieves this mission through education and prevention programs, advocacy, policy development, and support of medical research at the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine (BU CSTE). The BU CSTE was created in 2008 as a partnership between SLI, BU, and the Department of Veterans Affairs and conducts cutting-edge clinical and pathological research on the long-term effects of repetitive brain trauma, with a focus on the degenerative brain disease Chronic Traumatic Encephalopathy (CTE). For more information please visit SportsLegacy.org and HitCount.org.

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I fully endorse the actions and initiative of SLI as it relates to limiting exposure. Yes, this will cost money, but it is going to a defined set of goals and outcomes. This is also something as an athletic trainer I can actually use on the field, today. Unlike the NFL/GE grants awarded – whos goals and outcomes are worthy and can have an impact too – the Hit Count® Certified products can be utilized now, objectively. Although the overall goal of mine is to get certified athletic trainers at every collision practice and game, this will help in places that do not have that right now.

Please take the time to view the SLI Threshold White Paper so you can understand the logistics and thoughts of this Hit Count® program;

Regarding the actual threshold for a Hit, a review of the literature found that most sensors began registering impacts at between 10 and 15 g’s. Discussions with leading researchers revealed that the vast majority of necessary sports-specific movements involve less than 10 g’s of acceleration. However, some normal movements can exceed 10 g’s, and sometimes 15 g’s. However, there is no evidence that a 10 or 15 g impact causes any negative consequences for the brain, so capturing that data may be meaningless.

Currently, there is no evidence that normal activities can cause acceleration of 20 g’s. Based on the current published literature and expert opinion, a peak acceleration of 20 g’s always represents an abnormal movement of the head. A 20 g threshold was thought to be better than 10 or 15 g because it would not capture normal movement, or what researchers refer to as “noise.”

The available published literature was reviewed to explore whether impacts between 10 and 20 g’s had any known clinical significance. In the literature review, there was no specific data as to what impact thresholds begin causing subconcussive damage. Most of the recognized concussions began registering around 60 g’s and concussive impacts averaged 80 to 120 g’s.

With no published data providing evidence that impacts below 20 g’s create measurable changes in the brain*, and with the 20 g threshold appearing to have 100% sensitivity to abnormal head movement, it was unanimously agreed that 20 g fit the criteria the committee had set, listed again here:

The threshold should be sensitive to as many accelerations of the head that may cause brain injury as possible.

The threshold should be specificonly toabnormal accelerations of the head.

Future studies should explore this hypothesis, and SLI encourages researchers to continue to record impacts below 20 g’s to better understand their significance.

As Mike Haynes stated if a coach can see that his team is being exposed to a ton of registered impacts in a practice week, perhaps he/she can reevaluate the practice schedule and dial it back a bit. Every hit can make a difference in an athlete. How many times have we read/heard about the tragic cases where kids have befallen to brain injury only to be told that the “straw that broke the camels back” was an innocuous/routine hit?

The beauty of this plan and program is that there is not a “concussion threshold” being used here; a simple, sensitive and specific objective device to simply count. We all should understand that reducing the number of hits – in the case of Hit Count® 20 g’s – will in fact reduce the number of possible concussions. After full implementation of Hit Count® 1.o adjustments can be made to capture the ever evolving paradigm of concussions.

10 thoughts on “Hit Count® Has Come To Fruition”

Glenn BeckmannJanuary 27, 2014 / 16:45

Here’s what seems like a rhetorical question, but isn’t. How are these devices supposed to count impacts when the use of most of the devices from these after market product developers will render the helmets illegal to use in practices and games? Until these devices are certifiable to NOCSAE standards, the use of such devices – and the subsequent incentivizing consumers to put them in their helmets – is putting consumers directly in the liability stream for the helmet. Just a thought.

A very great question, Glenn… However there are now products that don’t need to be placed on a helmet or go against the NOCSAE requirements. Mouth guards, chin straps, head bands, skull caps, stickers, etc all are at or near market now… So maybe I was thinking this was the way they were going with this…

Fair enough. But our research into sensors in places other than on the head was inconclusive in terms of whether or not it provides an accurate measurement of an impact. The skull caps – maybe. As jbloggs said: this really smacks of unproven science being promoted as a new way to sell stuff to people looking for easy and simple answers. Time will tell. And God help the first consumer who is a defendant in the first lawsuit these devices will surely cause.

I am grateful that this type of research is to be done. I know Purdue University has been doing research with sensors for several years on the high school and university level. It seems that the majority of research is still in the pro or university/collegiate level.
I do have two questions or comments.
1. I have been told that the skull caps under or over the helmet voided the helmet warranty and go against NOCSAE requirements.
2. Being an athletic trainer on the secondary level in a rural school, the cost will be prohibitive for any of these devices.

Marianne,
I work for Schutt Sports. To the best of our knowledge, a skull cap that is fitted on the head does not void the helmet warranty, since it is not affixed or attached to the helmet. A cap that goes over the helmet, however, does void the warranty and also voids the NOCSAE certification. HTH

After reading the parts of the presentation deck that were posted, they are selling little more than a science experiment. Why 20gs? No rotational data collection. Arbitrary thresholds? You would think these people work for the NFL. Oh, they do.

Let me propose the following:

1) No coaches can take the field without having been an instructor in some capacity for 5 years (see John Wooden and Vince Lombardi);
2) No tackle until 14 or over;
3) No tackle play without on field medical care;
4) Fields must be in good condition;
5) Programs must mandate complete medical insurance;
6) Equipment must be verified to be in good condition; and
7) Teams must have a minimum number of players; and
8) Teams are placed in division by physical size and weight.

The suggestion above can be done now and will result in better play with less injuries. No need for unproven science. Less hits and less intense hits are certainly better but the implementation of cliff tests without scientific support is as bad as “Heads UP.”

– SLI does not work for the NFL.
– SLI’s Co-founder has proposed no tackle until 14.
– Simply go to their website
I would say you very much care about what goes on, but it’s still a step by step approach. Four years ago, nobody would have even accepted Hit Counts as a concept; now it is where it is. Changing ‘bell-rung’ culture is a long process. And there should always be devil’s advocates to make the education as concise as possible. But I’d also implore you to read up on SLI, Dr. Cantu and Chris Nowinski. The mission could not be in better hands.
– From football to lacrosse to the military to synchronized swimming (yes, up to a 50% concussion rate from being kicked in the head under water, the education needs to grow and it will not happen in one fell swoop).

Cantu also had problems with the catastrophic injury report produced with UNC.

Nowinski was kind enough to scare half the NFL by telling them, “they all had CTE.” without a shred of scientific evidence.

Now hit count the equally unvalidated cousin of Heads UP. Will SLI be providing cutoffs for children under 14 or will it play it clean? What are the ethics of conducting a scientific experiment on children sold as a safety program.

If you are so convinced the SLI/VA/BU program is above board, ask them to produce the funding agreements with the NFL. Make all the documents public and you might sway me. The NFL never provides funding without controlling the process.

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